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PRIOR CONDUCT INFORMATION AND RELEASE FORM

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Prior Misconduct Form - Header

Indiana University Southeast

General Information

Submit your prior conduct disclosure

If you have a previous offenses or a previous disciplinary action for nonacademic reasons at any high school, post-secondary institution, college, or university, you must complete this form as part of your application for admission.

Minor offenses do not require a committee review while more severe offenses are subject to have a prior misconduct review committee review your submitted information.

Note: If you have applied to other IU campuses for the same entry term, you will only need to complete one prior misconduct form.

Prior Conduct Information

Legal First Name: (* required)

Legal Middle Name:

Legal Last Name: (* required)

Date of Birth: (* required)

10-Digit University ID (if known):

IU Application number (if known):

What best describes your applicant status? (* required)

I have applied for undergraduate admission I have applied for graduate or professional admission

Personal Statement

Provide a statement that explains the above activities, and why you should be permitted to enroll at Indiana University.

This statement should detail the circumstances regarding the offenses stated above, including the events that led up to the disclosed events.

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I certify that all statements on this application are correct and complete. I understand that withholding pertinent information requested on this application or giving false information will make me ineligible for admission to Indiana University or subject to cancellation of admission if admission has already been granted or dismissal if already enrolled. I also grant my permission to Indiana University to access any and all records (including, but not limited to, those records held by law enforcement, judicial, university or college offices with records concerning my convictions or disciplinary actions) regarding the above incidents.

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Date (* required)

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Prior Misconduct Form - Header

General Information

Prior Conduct Information

Personal Statement

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